ABSTRACT

Introduction:

Anti-angiogenic treatment with anti-vascular endothelial growth factor (anti-VEGF) for patients with exudative neovascular age-related macular degeneration (AMD) is the most effective in slowing the progression of visual loss and is first choice therapy. The safety data in patients with cerebrovascular accidents (CVA) in the last 6 months is limited since this condition has been considered as an exclusion criterion in most trials. Although, at the theoretical level, anti-VEG are capable of causing CVA, there is currently controversy in the literature on whether the use of anti-VEGF, especially frequent, increases the incidence of stroke. Intraocular corticosteroids have been widely used in ophthalmological practice in the control of intraocular inflammation and inhibition of neovascularization, and their use in exudative AMD is performed in combination treatments.

Case report:

An 81-year-old male patient with a history of hypertension and pseudophakia in both eyes, and unique functional left eye (LE) due to atrophic AMD in right eye, referred central metamorphopsia in LE of 24 hours of evolution. On examination, LE ETDRS visual acuity of 45 letters, with fundoscopic and OCT image of active neovascular membrane was seen. It was oriented as exudative AMD and intravitreal treatment was initiated with loading dose of anti-VEGF. Afterwards, the patient presented a small disciform scar. During the follow-up a stroke occurred. He was kept under observation, but when intraretinal hemorrhages happened, therapeutic management with Dexametasone implant (Ozurdex) was reconsidered. In the control, ETDRS was maintained in 45 letters and the juxtalesional neurosensory detachment disappeared.

Conclusion:

Currently there is no evidence to support the use of anti-VEGF in exudative AMD patients with a stroke history in the last 6 months. It is necessary to individualize each case and weigh the risks and benefits. The antiangiogenic effect of corticosteroids in the exposed case has allowed control of the disease.


CONTACT DETAILS

Vladimir POPOSKI*, F. DOLZ, Daniela POPOSKA, Isaac ALARCON VALERO, H. BROSA, S. KHAOULY, Daniel VILAPLANA
Hospital de l’Esperança – Parc de Salut Mar
Barcelona
Spain
Email : vpoposki@hotmail.com
Cell Phone: +34653633547
Work Phone: +34933674159